I will post here some of what came up in a discussion so that those that were not in class can also hear about some of the tangents we went off on.I will also put some additional information about the topics. Stuttering: Many young kids go through a stage between the ages of 2 and5 when they stutter, repeating certain syllables, words orphrases, prolonging them, or stopping, making no sound for certain sounds and syllables. Stuttering is a form of dysfluency —an interruption in the flow of speech.
In many cases, stuttering goes away on its own by age 5; in others, it lasts longer.
What Causes Stuttering?
Experts think that a variety of factors contribute to stuttering,including:
Genetics: About 60% of those who stutter have a close family member who stutters.
Other speech and language problems or developmental delays.
Differences in the brain's processing of language: People who stutter process language in different areas of the brain and there's a problem with the way the brain's messages interactvwith the muscles and body parts needed for speaking.
Early Signs of Stuttering
The first signs of stuttering tend to appear when a child is about18-24 months old as there is a burst in vocabulary and kids arevstarting to put words together to form sentences. To parents, the stuttering may be upsetting and frustrating, but it is natural for kids to do some stuttering at this stage. It's important to be as patient with your child as possible.
A child may stutter for a few weeks or several months, and the stuttering may be sporadic. Most kids who begin stuttering beforethe age of 5 stop without any need for interventions such as speech or language therapy.
However, if your child's stuttering is frequent, continues to get worse, and is accompanied by body or facial movements, an evaluation by a speech and language pathologist around (instead of before) age 3 is a good idea. I also hear this dysfluencies when a kindergartner or first grader is trying to talk and they are rushing or afraid someone will not listen or will interrupt them. They quest to get the information out quickly often results in false starts or repetitions..
LISPING When /s/ and /z/ are hard to say Bowen, C. (1999). Lisping: When /s/ and /z/ are hard to say. Retrieved from http://www.speech-language-therapy.com/lisping.htm on November 30,2011 This article has been modified from original content.
What is a lisp?
A lisp is a Functional Speech Disorder (FSD). A functional speech disorder is a difficulty learning to make a specific speech sound, or a few specific speech sounds.
The word 'functional' means that the cause of the disorder is not known. Indeed, in some (recent) literature FSDs are referred to as "speech delay of unknown origin" or "speech disorder of unknown origin".
Functional speech disorders, or speech delays of unknown origin, may persist into adolescence and adulthood as "residual errors". They can be treated successfully in motivated children and adults.
Where does the problem lie?
The speech difficulty in a child with a functional speech disorder is probably at a phonetic level: that is, the child has a particular difficulty producing certain sounds correctly. Alternatively, the child has learned to say a sound, or sounds, the wrong way, and the incorrect pronunciation has become a habit.
Characteristics of lisping
Typically, when a person lisps their tongue either protrudes between, or touches, their front teeth and the sound they make is more like a 'th' than a /s/ or /z/.
Protruding the tongue between the front teeth while attempting /s/ or /z/ is referred to as 'interdental' production, and touching the front teeth with the tongue while attempting to produce /s/ or /z/ is called 'dentalised' production.
There are two other types of lisp: the lateral lisp, and the palatal lisp. In a lateral lisp the person produces the 's' and 'z' sounds with the air escaping over the sides of the tongue, while in a palatal lisp they attempt to make the sounds with the tongue in contact with the palate. The four types of lisp are described in more detail below.
Is a lisp ever 'normal'?
It is a perfectly normal developmental phase for some (not all) children to produce interdental or dentalised /s/ and /z/ sounds until they are about 4½ years of age. There are age norms here. On the other hand, neither lateral or palatal lisps are part of the normal developmental progression. The speech of a child with a lateral or palatal lisp should be assessed, by a speech-language pathologist, without delay.
Intelligibility
Lisping, as an isolated speech characteristic, does not usually reduce the person's intelligibilityunduly. Most people can easily understand what the person with a lisp is saying.
Grow up now
Sometimes children's lisps are regarded as cute until they reach a certain age at which time the same adults who have almost been encouraging them to lisp decide abruptly that it is high time they "grew out of it". I have often wondered what it can be like for four and five year olds in this situation.
Four types of lisp 1. Interdental (frontal) lisp
In an interdental lisp (or frontal lisp) the tongue protrudes between the front teeth and the air-flow is directed forwards. The /s/ and /z/ sound like 'th'. Children developing speech along typical lines may have interdental lisps until they are about 4½ - after which they disappear. If they don't 'disappear' an SLP assessment is indicated.
Interdental /s/
Words such as 'soup', 'missing' and 'pass', which all contain the voiceless alveolar fricative consonant /s/ are pronounced 'thoop', 'mithing' and 'path'. The voiceless 'th' sound that occurs in a word like 'thing' (or a sound very much like it) replaces the /s/. Interdental /z/
Words like 'zoo', 'easy' and 'buzz' which all contain the voiced alveolar fricative consonant /z/ are pronounced 'thoo', 'eethee' and 'buth'. The voiced 'th' sound that occurs in a word like 'them' (or a sound very much like it) replaces the /z/. 2. 'Dentalised lisp'
'Dentalised lisp' is not an 'official' diagnostic term. It is an expression (like 'dentalised production') that SLPs use to describe the way an individual is producing certain sounds. The tongue rests on, or pushes against, the front teeth, the air-flow is directed forwards, producing a slightly muffled sound.
Typically developing children (in terms of their speech) may produce dentalised variants of /s/ and /z/ until around 4½ years - and then grow out of it. If they don't grow out of it, an SLP assessment is indicated. 3. Lateral lisp
Lateral lisps are not found in typical speech development. The tongue position for a lateral lisp is very close to the normal position for /l/ and the sound is made with the air-flow directed over the sides of the tongue. Because of the way it sounds, this sort of lisp is sometimes referred to as a 'slushy ess' or a 'slushy lisp'. A lateral lisp often sounds 'wet' or 'spitty'. Unlike interdental and dentalised lisps, lateral lisps are not characteristic of normal development. An SLP assessment is indicated for anyone with a lateral lisp.
4. Palatal lisp
Palatal lisps are not found in typical speech development. Here, the mid-section of the tongue comes in contact with the soft palate, quite far back. If you try to produce a /ç/ - or a 'h' closely followed by a 'y', and prolong it, you more or less have the sound. Unlike interdental and dentalised lisps, palatal lisps are not characteristic of normal development. An SLP assessment is indicated for anyone with a palatal lisp. 'sh', 'zh', 'ch', 'j'
Sometimes children and adults who lisp when they attempt to say /s/ and /z/ also have tongue placement problems when they try to say 'sh' as in 'shoe', 'zh' as in measure, 'ch' as in 'chair', and 'j' as in 'jump'. They may dentalise these sounds, or produce them interdentally, or produce them with lateral air escape, or with excessive palate to tongue contact. "...everything seems interdental"
Some children produce many sounds interdentally. Tongue protrusion, or very 'forward' or 'anterior' tongue placement may be observed when they say not only /s/, /z/, 'sh', 'zh', 'ch' and 'j', but also /n/, /l/ and other sounds.
In some children "everything" seems interdental. This may sometimes be an indication that the nose is constantly obstructed, due for instance, to allergy, infection, large adenoids or craniofacial anomalies, or may be associated with habitual mouth breathing, tongue thrust, or sucking habits. Waiting
Studies to confirm it are unavailable as far as I know, but I think most SLPs would agree that in their clinical experience there is a greater likelihood that children will "grow out of" interdental or dentalised lisps than lateral or palatal lisps.
Referral and assessment
Young children are usually referred for assessment of lisps by their parents or caregivers, often on the advice of pre-school teachers. It is, of course, uncommon for SLPs to attempt to treat an interdental lisp, or dentalised production of /s/ and /z/, in children under 4½ years of age, because it is regarded as normal for them to produce the sounds that way. They may, however, be interested in assessing children under 4½ who are reported to be lisping, in order to see whether it is a lisp, and, if so, what type of lisp it is. Treatment for a lateral or palatal lisp may be appropriate in children under 4½.
The assessment process
Assessment involves screening all areas of communicative function. The SLP takes a detailed history, examines the anatomy of the mouth and the movements it can make (checking fortongue tie, palate structure and function, swallowing patterns and so on), takes a speech and language sample for analysis, and observes voice quality, fluency, and semantic and pragmatic skills skills.
Sometimes it may emerge that although a child is having difficulty saying /s/ and /z/, he or she is not actually lisping. These children may have some other speech sound disorder.
Omitting /s/ and /z/ (sun = un, tease = tee) or replacing them with consonants like /w/ or /d/ (sun = wun, so = doe) are not forms of lisping. Children with these sound replacements may be having phonological difficulties.
T Most speech-language pathologists will use a "Traditional Articulation Therapy" approach, or variations of it (see Judith Duchan's site for an interesting history of its development). Let's say that the client in the following example has an interdental lisp. In essence, her therapy will be like this:
We will determine that the client can hear the difference between /s/ and 'th' as individual sounds, and in words (e.g., sink / think).
We will do some auditory bombardment or focused auditory input. There are word lists and word contrasts here that could be used at this stage.
Using tactile, auditory and motoric cues we will teach the client to make the new /s/ sound.
We will choose a word-position (let's say, for the sake of the example, that we choose the initial position).
Using motor cues we teach the client to imitate and the produce independently /s/ in isolation
... in broken syllables
(s-oo s-ee s-or s-ie s-oh...)
…in syllables
(soo see sor sie soh...)
…in words
(Sue see saw sigh sew...sun sip soap...)
…in phrases
(so silly, send sam, seven seals)
…in sentences
(I see a sock...)
…in controlled conversational contexts
(e.g., during dinner)
…in conversation
…phasing out modelling and reinforcement
...and working towards self-monitoring and self-correction.
At each step in the process the client will practice under the supervision of an adult. Brief, frequent practice periods work best.
There is a good description of various approaches and techniques in this book:
Stuttering:
Many young kids go through a stage between the ages of 2 and5 when they stutter, repeating certain syllables, words orphrases, prolonging them, or stopping, making no sound for certain sounds and syllables.
Stuttering is a form of dysfluency —an interruption in the flow of speech.
In many cases, stuttering goes away on its own by age 5; in others, it lasts longer.
What Causes Stuttering?
Experts think that a variety of factors contribute to stuttering,including:Early Signs of Stuttering
The first signs of stuttering tend to appear when a child is about18-24 months old as there is a burst in vocabulary and kids arevstarting to put words together to form sentences. To parents, the stuttering may be upsetting and frustrating, but it is natural for kids to do some stuttering at this stage. It's important to be as patient with your child as possible.A child may stutter for a few weeks or several months, and the stuttering may be sporadic. Most kids who begin stuttering beforethe age of 5 stop without any need for interventions such as speech or language therapy.
However, if your child's stuttering is frequent, continues to get worse, and is accompanied by body or facial movements, an evaluation by a speech and language pathologist around (instead of before) age 3 is a good idea.
I also hear this dysfluencies when a kindergartner or first grader is trying to talk and they are rushing or afraid someone will not listen or will interrupt them. They quest to get the information out quickly often results in false starts or repetitions..
When /s/ and /z/ are hard to say
Bowen, C. (1999). Lisping: When /s/ and /z/ are hard to say. Retrieved from http://www.speech-language-therapy.com/lisping.htm on November 30,2011
This article has been modified from original content.
A lisp is a Functional Speech Disorder (FSD). A functional speech disorder is a difficulty learning to make a specific speech sound, or a few specific speech sounds.
The word 'functional' means that the cause of the disorder is not known. Indeed, in some (recent) literature FSDs are referred to as "speech delay of unknown origin" or "speech disorder of unknown origin".
Functional speech disorders, or speech delays of unknown origin, may persist into adolescence and adulthood as "residual errors". They can be treated successfully in motivated children and adults.
Where does the problem lie?
The speech difficulty in a child with a functional speech disorder is probably at a phonetic level: that is, the child has a particular difficulty producing certain sounds correctly. Alternatively, the child has learned to say a sound, or sounds, the wrong way, and the incorrect pronunciation has become a habit.
Characteristics of lisping
Typically, when a person lisps their tongue either protrudes between, or touches, their front teeth and the sound they make is more like a 'th' than a /s/ or /z/.
Protruding the tongue between the front teeth while attempting /s/ or /z/ is referred to as 'interdental' production, and touching the front teeth with the tongue while attempting to produce /s/ or /z/ is called 'dentalised' production.
There are two other types of lisp: the lateral lisp, and the palatal lisp. In a lateral lisp the person produces the 's' and 'z' sounds with the air escaping over the sides of the tongue, while in a palatal lisp they attempt to make the sounds with the tongue in contact with the palate.
The four types of lisp are described in more detail below.
Is a lisp ever 'normal'?
It is a perfectly normal developmental phase for some (not all) children to produce interdental or dentalised /s/ and /z/ sounds until they are about 4½ years of age. There are age norms here.
On the other hand, neither lateral or palatal lisps are part of the normal developmental progression. The speech of a child with a lateral or palatal lisp should be assessed, by a speech-language pathologist, without delay.
Intelligibility
Lisping, as an isolated speech characteristic, does not usually reduce the person's intelligibilityunduly. Most people can easily understand what the person with a lisp is saying.
Grow up now
Sometimes children's lisps are regarded as cute until they reach a certain age at which time the same adults who have almost been encouraging them to lisp decide abruptly that it is high time they "grew out of it". I have often wondered what it can be like for four and five year olds in this situation.
Four types of lisp
1. Interdental (frontal) lisp
In an interdental lisp (or frontal lisp) the tongue protrudes between the front teeth and the air-flow is directed forwards. The /s/ and /z/ sound like 'th'.
Children developing speech along typical lines may have interdental lisps until they are about 4½ - after which they disappear. If they don't 'disappear' an SLP assessment is indicated.
Interdental /s/
Words such as 'soup', 'missing' and 'pass', which all contain the voiceless alveolar fricative consonant /s/ are pronounced 'thoop', 'mithing' and 'path'. The voiceless 'th' sound that occurs in a word like 'thing' (or a sound very much like it) replaces the /s/.
Interdental /z/
Words like 'zoo', 'easy' and 'buzz' which all contain the voiced alveolar fricative consonant /z/ are pronounced 'thoo', 'eethee' and 'buth'. The voiced 'th' sound that occurs in a word like 'them' (or a sound very much like it) replaces the /z/.
2. 'Dentalised lisp'
'Dentalised lisp' is not an 'official' diagnostic term. It is an expression (like 'dentalised production') that SLPs use to describe the way an individual is producing certain sounds. The tongue rests on, or pushes against, the front teeth, the air-flow is directed forwards, producing a slightly muffled sound.
Typically developing children (in terms of their speech) may produce dentalised variants of /s/ and /z/ until around 4½ years - and then grow out of it. If they don't grow out of it, an SLP assessment is indicated.
3. Lateral lisp
Lateral lisps are not found in typical speech development. The tongue position for a lateral lisp is very close to the normal position for /l/ and the sound is made with the air-flow directed over the sides of the tongue. Because of the way it sounds, this sort of lisp is sometimes referred to as a 'slushy ess' or a 'slushy lisp'. A lateral lisp often sounds 'wet' or 'spitty'.
Unlike interdental and dentalised lisps, lateral lisps are not characteristic of normal development. An SLP assessment is indicated for anyone with a lateral lisp.
4. Palatal lisp
Palatal lisps are not found in typical speech development. Here, the mid-section of the tongue comes in contact with the soft palate, quite far back. If you try to produce a /ç/ - or a 'h' closely followed by a 'y', and prolong it, you more or less have the sound.
Unlike interdental and dentalised lisps, palatal lisps are not characteristic of normal development. An SLP assessment is indicated for anyone with a palatal lisp.
'sh', 'zh', 'ch', 'j'
Sometimes children and adults who lisp when they attempt to say /s/ and /z/ also have tongue placement problems when they try to say 'sh' as in 'shoe', 'zh' as in measure, 'ch' as in 'chair', and 'j' as in 'jump'.
They may dentalise these sounds, or produce them interdentally, or produce them with lateral air escape, or with excessive palate to tongue contact.
"...everything seems interdental"
Some children produce many sounds interdentally. Tongue protrusion, or very 'forward' or 'anterior' tongue placement may be observed when they say not only /s/, /z/, 'sh', 'zh', 'ch' and 'j', but also /n/, /l/ and other sounds.
In some children "everything" seems interdental. This may sometimes be an indication that the nose is constantly obstructed, due for instance, to allergy, infection, large adenoids or craniofacial anomalies, or may be associated with habitual mouth breathing, tongue thrust, or sucking habits.
Waiting
Studies to confirm it are unavailable as far as I know, but I think most SLPs would agree that in their clinical experience there is a greater likelihood that children will "grow out of" interdental or dentalised lisps than lateral or palatal lisps.
Referral and assessment
Young children are usually referred for assessment of lisps by their parents or caregivers, often on the advice of pre-school teachers.
It is, of course, uncommon for SLPs to attempt to treat an interdental lisp, or dentalised production of /s/ and /z/, in children under 4½ years of age, because it is regarded as normal for them to produce the sounds that way. They may, however, be interested in assessing children under 4½ who are reported to be lisping, in order to see whether it is a lisp, and, if so, what type of lisp it is. Treatment for a lateral or palatal lisp may be appropriate in children under 4½.
The assessment process
Assessment involves screening all areas of communicative function. The SLP takes a detailed history, examines the anatomy of the mouth and the movements it can make (checking for tongue tie, palate structure and function, swallowing patterns and so on), takes a speech and language sample for analysis, and observes voice quality, fluency, and semantic and pragmatic skills skills.
Sometimes it may emerge that although a child is having difficulty saying /s/ and /z/, he or she is not actually lisping. These children may have some other speech sound disorder.
Omitting /s/ and /z/ (sun = un, tease = tee) or replacing them with consonants like /w/ or /d/ (sun = wun, so = doe) are not forms of lisping. Children with these sound replacements may be having phonological difficulties.
T
Most speech-language pathologists will use a "Traditional Articulation Therapy" approach, or variations of it (see Judith Duchan's site for an interesting history of its development).
Let's say that the client in the following example has an interdental lisp. In essence, her therapy will be like this:
- We will determine that the client can hear the difference between /s/ and 'th' as individual sounds, and in words (e.g., sink / think).
- We will do some auditory bombardment or focused auditory input. There are word lists and word contrasts here that could be used at this stage.
- Using tactile, auditory and motoric cues we will teach the client to make the new /s/ sound.
- We will choose a word-position (let's say, for the sake of the example, that we choose the initial position).
- Using motor cues we teach the client to imitate and the produce independently /s/ in isolation
- ... in broken syllables
- …in syllables
- …in words
- …in phrases
- …in sentences
- …in controlled conversational contexts
- …in conversation
- …phasing out modelling and reinforcement
- ...and working towards self-monitoring and self-correction.
At each step in the process the client will practice under the supervision of an adult. Brief, frequent practice periods work best.(s-oo s-ee s-or s-ie s-oh...)
(soo see sor sie soh...)
(Sue see saw sigh sew...sun sip soap...)
(so silly, send sam, seven seals)
(I see a sock...)
(e.g., during dinner)
There is a good description of various approaches and techniques in this book:
Bernthal, J. E., Bankson, N. W., & Flipsen, P., Jr. (2009). Articulation and Phonological Disorders,6th Ed. Boston, MA: Pearson Education. LINK
The Butterfly Procedure
Imagery and the Butterfly Position